Background and objective
The question of the psychopathological consequences of early sexual abuse has been a nuclear topic in psychoanalytic studies, but has received little attention in clinical psychiatry until recent years. On one side, the literature stresses the pathogenic value of early sexual abuse in different psychiatric disorders and their course, on the other side, the description of the False Memory Syndrome raises the issue of the low reliability of some of the memories of early sexual abuse that emerge frequently in the course of acute psychoses or dissociative states.
From July 2008 to September 2010 the Authors have interviewed all female patients consequently admitted in a unit for acute inpatients or in emergency settings, asking them if they had been sexually abused in childhood or adolescence. The patients who referred to be abused were evaluated with an ad hoc Questionnaire to establish the main details of the abuse and the reliability of their report. Some criteria to classify the abuse as True, Possible or Unlikely were defined. Then the patients were assigned to a DSM-IV category using the SCID-I and the SCID-II. Some patients were interviewed again during subsequent admissions.
In about 2 years, 46 patients (mean age 41.3) were identified. Most reports (27) were considered “True”, 11 “Possible”, 9 “Unlikely” (one patient had both “True” and “Unlikely” evaluations). The types of sexual abuse were highly heterogeneous, spanning from repeated incest to incest attempts to more ephemeral experiences, but all had a traumatic quality and were well fixed in patient’s memory. However, 30% of patients refered a long period of amnesia and the revelation of the episodes very often is simultaneous with the first or subsequent episodes of the mental disorder.
The patients were assigned mainly to Mood Disorders and Borderline Personality Disorders categories, but most of the “Unlikely” statements had delusional qualities and emerged during psychotic episodes or relapses. Some patients fulfil criteria for Anxiety Disorders and those of the so called “False Memory Syndrome”. The degree of certainty may change in some cases in following interviews.
The issue of the pathogenic value of the abuse statements cannot be answered definitively due to the lack of a comparision with non patients. From a psychopathological and clinical point of view, these experiences have a high subjective impact: “True” abuses can be considered non-specific pathogenic factor, “Possible” abuses may constitute a frequently recurring theme under the form of doubt of traumatic experiences in the course of acute relapses of the different disorders, while “Unlikely” abuses represent a more or less structured theme that is created ex novo by the pathologic state. However the differentiation of these sub-categories is often arbitrary or unsatisfying. The hypothesis of a “psychopathological continuum” in the degree of truthfulness of early sexual abuse more exactly describes their clinical manifestations.
Most patients show sexual disorders and high instability in their sexual relationships, hence the emergence of these themes may be considered as a sexual conflict index.